Woman happy to learn she has ADHD

DEAR DR. ROACH: I am a 47-year-old woman, and I’ve dealt with inherited major depressive disorder since my teens. Drug treatment has always given me moderate relief.

Two years ago, I described to my new doctor my lifelong tendency to have shifting moods (best in the mornings, worst in the evenings) and my difficulty staying focused. He added a daily dose of Lamictal to my already-prescribed Pristiq.

Since then, I’ve felt, simply put, “normal” for the first time in my life. My moods are far more stable, and I can concentrate on whatever I want without extreme effort. Absentmindedness is no longer a problem. I couldn’t believe my relief, and I asked him where this drug had been all this time.

He smiled and quietly asked me whether anyone in my family had ever been diagnosed with ADHD. I was shocked. I come from a stable and intelligent family of high achievers. I am not supposed to have what many consider a “learning disability,” but now I believe that had I been medicated, I’d have had a much easier, happier life to date. I’m sure my ancestors would have as well.

In short, I am asking you to convey to your readers that they should never stigmatize ADHD like I did, because its symptoms are easily masked within mood disorders, and one problem can worsen the other. Just ask to be screened. It may really help. Thanks for spreading the word.

ANSWER: Making diagnoses in psychiatry can be difficult. There isn’t a lab test or imaging study to confirm the diagnosis, and the symptoms people notice can overlap among several different conditions, treatment for which can vary widely.

For instance, people with symptoms of depression (such as depressed mood and little interest in pleasurable activities) may have an obvious diagnosis: major depression. However, they may instead have bipolar disease type 2. To make this diagnosis, there must have been at least one episode where a person had “hypomania”: a period of symptoms including increased energy, elevated mood and little need for sleep, lasting at least four days. This may not be recalled by the patient, and the diagnosis can go unmade. This is important because the treatments are different.

I mention bipolar 2 because lamotrigine (Lamictal) is a treatment for bipolar disease. It acts as a mood stabilizer. It also sometimes is used in people with ADHD, as it helps with the side effects of stimulants.

I honestly don’t have enough information to say whether you have ADHD, bipolar disease, both, or neither. There are diagnostic criteria and a screening test that can be done for ADHD (see add.org/adhd-test/).

I should add that many people, both those with ADHD and those with bipolar disease, perform at extremely high levels. I have had people write to me that they feel successful partly because of, rather than in spite of, their ADHD.

In the future, we may have better success prescribing medications based on someone’s genes in addition to their symptoms — there already is promising research in this area. What is clear is that it sometimes takes more than one expert to find the right treatment, including medication (or combination) in people with a serious psychiatric illness.

DEAR DR. ROACH: A few months ago, an oncoming driver lost control of his car and hit me almost head-on, destroying my large SUV.

Both vehicles were traveling about 40 m.p.h., and we had less than one second to react. Although I was belted and all of the air bags worked, my body rotated counterclockwise. All of the emergency-room attention and follow-up was on my right arm and shoulder.

As I was recovering, my wife asked if I was gaining weight, as my stomach was looking very large. She believed I had a separation of my abdominal muscles, and a doctor I saw in Europe confirmed this. I have a perfect tent that runs from roughly my navel to the base of my sternum. It is wide and tall and symmetrical.

Could the accident have caused this? How do I get my abs corrected?

ANSWER: It sounds as though you have diastasis recti, a separation of the left and right halves of your abdominal muscle. The contents of the abdomen will push outward where the connective tissue separates the muscle. Some people are born with this condition, but I see it most in people who have had weight gain that separates the muscle. Normal pregnancy is a common reason.

Although I had never heard of it, I did find a case report of a person who had separation of the stomach muscles in a motor vehicle accident. The seat belt (which undoubtedly helped save your life) can put enough stress on the connective tissue (called the linea alba) to separate the muscles. Of course, it’s possible it was there before and you just didn’t notice it (this seems unlikely, but it would be more likely if your weight changed after the collision).

Exercise programs may help with this problem, ideally supervised by a physical therapist. Another option is the Tupler technique, which involves a splint device to reduce the pressure stretching the linea alba, followed by exercise: The idea makes sense, but it hasn’t been proven to be effective. Surgery is another option for large defects.

DEAR DR. ROACH: In regard to a recent column on a 65-year-old losing hair on his legs, your answer hit on everything — except his diabetes.

When I developed Type 2 diabetes and started to see a podiatrist, he commented during the foot exam that the loss of hairs on one’s feet and lower part of the legs is very typical of someone with diabetes, because of nerve damage. You did not mention Type 2 diabetes at all! Was my podiatrist right?

ANSWER: Diabetes can indeed cause nerve damage, and the most common places the symptoms begin are the bottom of the feet and ankles. However, hair loss is not part of the nerve problem from diabetes.

People with longstanding diabetes, especially if not well-controlled, are at higher risk of developing blockages in the small and large blood vessels of the feet. Since this can start about the same time as diabetic neuropathy, the message from the podiatrist may have been confusing. Yes, it could be the diabetes, but it’s the blood vessel damage, not the nerve damage, that seems to be most associated with hair loss.

READERS: The booklet on abnormal heart rhythms explains atrial fibrillation and the more common heart rhythm disturbances in greater detail. Readers can obtain a copy by writing: Dr. Roach, Book No. 107, 628 Virginia Dr., Orlando, Fla., U.S.A., 32803

Enclose a cheque or money order for C$6 with the recipient’s printed name and address. Please allow four weeks for delivery.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at 628 Virginia Dr., Orlando, Fla., U.S.A., 32803. Health newsletters may be ordered from rbmamall.com.